Prescriptions for painkillers brought about the explosion in heroin use in America's suburbs

Andi
Peterson, seen in a mugshot (left) and several years after
treatment (right).Weber County
Sheriff's Department (left); Courtesy of Andi Peterson (right);
Photo Illustration by Skye Gould / Business
Insider

Andi Peterson never thought twice about taking Percocet. After
all, the powerful painkiller had been prescribed by
a doctor.

"I didn't think what I was doing was that wrong. It felt more
like a have-fun-once-in-a-while thing. It was not going to lead
to this crazy addiction," she told Business Insider.

The first time Peterson tried Percocet she was 16. The last time
she used any substance was when she was 23, she said. She was
finally free from the addiction that had spiraled from
painkillers to heroin and cost her custody of her son, tens of
thousands of dollars, and a year in prison.

Peterson is the face of what America's drug epidemic looks like
today. She is young, white, and middle-class, and she lives not
in a city but in a suburb. She has been part of an epidemic
ripping through towns and cities that's left a trail of broken
families and struggling addicts in recovery — and many others not
as lucky as Peterson.

The US Centers for Disease Control and Prevention has estimated
that the crisis costs
the US $78.5 billion a year and strains state and local
governments and the healthcare system. In December, the CDC also
reported that 52,404
people died from drug overdoses in 2015. Those overdoses have
fallen hard on places like Weber County, Utah, where Peterson
grew up. Weber County's drug-overdose death rate is more
than five times what it was a decade ago, and far above the
national average.

Depending on the dosage, all medicine is poison

Weber County was built on a foundation of working-class jobs — in
railroad and steel — which supported the middle-class for
decades. But by the 1990s, those industries had disappeared after
the shift to aviation and automation. That sent the county
into a downturn. A similar story played out across the country.
In Ohio and Pennsylvania, it was manufacturing and the steel
industry. In West Virginia, it was coal mining.

At the same time that these industries were collapsing,
pharmaceutical reps and medical professionals began pushing
opioid painkillers as an effective and low-risk treatment for
pain, based on
a now debunked study that suggested fewer than 1% of opioid
users become addicted.

While many prescriptions went to patients in need of pain relief,
many more went to those suffering less serious ailments. In the
1990s and early 2000s, doctors prescribed opioids "for
everything," Dr. Houman Danesh, the director
of Integrative Pain Management at Mount Sinai Hospital, told
Business Insider last year. Many primary-care doctors, who
prescribe the vast majority of opioids, didn't fully understand
the risks of the drugs.

A slippery slope

In
Utah, Mark Lewis holds a photograph of his son, who died from a
heroin overdose.AP Photo/Rick
Bowmer

Peterson was 16 when a friend of hers was prescribed Lortab,
another powerful painkiller, for back pain. The friend offered a
Lortab pill to her and Peterson gave it a try, despite having
never so much as drunk a beer before. She was a shy kid who
suffered social anxiety, and the pills took that away.
Painkillers don't just numb physical pain; they numb emotional
distress as well.

"I remember feeling really good and comfortable in my own skin
for once. I felt like I could talk to people," Peterson said.

Two years later she had an emergency C-section while giving birth
to her son, Caden, who was born prematurely. To deal with the
pain, doctors prescribed her Percocet. Peterson's son's life was
in danger, and she traveled every day to the hospital to visit
him. And she found that the painkillers eased her stress.

A few months later, while Peterson was working at Walmart, a new
boyfriend showed up with Percocet. They finished a bottle's worth
in a matter of days. After they used Percocet for a week,
Peterson's boyfriend suggested they try heroin. It didn't scare
her. It just seemed like a cheaper option.

"It didn't seem like a big deal to me then," she said. "I was
naive. I didn't know all the consequences that it would lead to.
It just made me feel good. Normal."

Angela Stander, a coordinator at the Utah Department of Health,
had heard a lot of stories like Peterson's when she worked at a
youth treatment center in Salt Lake City. Again and again, white
middle-class teens would come into Stander's treatment center
hooked on prescription painkillers. Some had tried painkillers
for the first time after being prescribed the drugs; others stole
them from their parents or got them at parties.

Greater than
50% of Americans who misused painkillers in 2015 obtained
them from a friend or relative who got them from a doctor. Often,
Stander would see a patient leave, only to return months later
addicted to heroin. Middle-class people "don't perceive
themselves as addicts. Then they start to use more and more and
they overdose," Stander told Business Insider.

More readily available, inexpensive, and potent

The pills-to-heroin pipeline is largely responsible for the
explosion in heroin use in America's suburbs.

Dr. Ted Cicero, a professor of psychiatry at Washington
University in St. Louis, conducted an extensive study on opioid
users' habits in 2015. He found they overwhelmingly follow a
"natural progression" from prescription pills to heroin as the
price for pills becomes prohibitive.

When people like Peterson are ready to make the jump, heroin is
not only more readily available and cheaper but also more potent
than ever.

Skye Gould/Business Insider

As journalist Sam Quinones wrote in "Dreamland:
The True Tale of America's Opiate Epidemic," as the pill
crisis deepened, heroin dealers (primarily from Xalisco County,
Mexico) moved in to supply a new population of users in places
not traditionally known for criminal activity or drug dealing.

Suburbs hit hard by the crisis, like Weber County, were full of
painkiller users primed for the switch to heroin. The Xalisco
dealers, and others like them, catered their businesses to these
users. The dealers offered hassle-free delivery to popular
suburban locations, like McDonald's or a CVS parking lot.

Well paid by higher-ups, the dealers didn't rip off addicts with
weak heroin or steal from them. Instead, they treated them as
important customers, offering discounts on holidays and freebies
when they were short on cash.

"Guys from Xalisco had figured out that what white people —
especially middle-class white kids — want most is service,
convenience," Quinones wrote.

Further, the Xalisco dealers, and the cartel-associated dealers
that came after, avoided selling in black neighborhoods and to
African-Americans because so many Mexicans told tales of gang
violence in places like Los Angeles, according to Quinones.

"A lot of them were using with friends," Daly told Business
Insider last year. "The minute one friend said, 'Hey, my dealer
hooked me up with this awesome, super cheap stuff — try it,' the
kids would try it.

"Once they tried heroin, there was no going back. Even if they
wanted to stop, they were physically unable."

'It was like breathing'

A
detainee bangs on the window of his cell as heroin-awareness and
advocacy groups rally on the steps of the Hamilton County Justice
Center to demand action after a wave of overdoses hit the
region.AP Photo/John Minchillo,
File

After six months, Peterson's step-dad, a highway patrolman, knew
something was up. Peterson was fidgety and sweating at the time
from smoking heroin. He sat her down and without much prodding
she fessed up. She told her parents that she was ashamed and
wanted to get clean.

Her dad, Cory, was in shock but tried to be positive. He took her
to the family doctor, who prescribed drugs to ease her withdrawal
and told them to get Peterson into a program.

"Everything sounded really good in the doctor's office. We walked
outside of the office, and I had a lot of hope that we had caught
it just in time," Cory told Business Insider.

Then reality hit. Peterson went through detox and a month-long
outpatient treatment program at the Alcohol and Chemical
Treatment Center, the biggest in Weber County. It went well at
first, she thought. But on the last day her tax refund arrived.
She cashed the check and drove to her boyfriend's house. The urge
was too strong. Within a week she learned how to inject heroin.

Opioids fundamentally
rewire the brain and radically change thought patterns.
Imagine a chorus shouting in your head "I need to use heroin"
endlessly until the moment you gave in. That's what addiction
feels like to the heaviest heroin and painkiller users, many say.

Once a person becomes hooked, it becomes difficult and expensive
to get them back to anything like a stable life. Even for those
like Peterson, with supportive parents and good health insurance,
it can take years to get clean, if ever. Justin Hatch, the
program director at ACT, told Business Insider that patients
frequently take up to seven stays in treatment to reach "full
recovery." Peterson would go to treatment more than five times
over the next two years.

Getting high "required no thought," Peterson said. "It was like
breathing."

The destruction that opioids have wrought on suburbia is directly
linked to how difficult the addiction is to cure on an individual
level. There is no standardized treatment for opioid-use
disorder, and many treatment centers are built around treating
alcoholism, essentially a different brain disorder.

Medication-assisted treatment, which uses prescription medication
to reduce cravings and is considered to be the
gold standard, has gained advocates in statehouses and
Capitol Hill, but is expensive and
not yet widely available.

Hard-hit counties have started to take matters into their own
hands. Weber Human Services, the substance-use service authority
in Weber and Morgan counties, has worked to make MAT more
available and accessible, both through public funds and outreach
to doctors and treatment centers. But its use is still more the
exception than the rule.

'One more overdose, I was done'

Robert Done has been a police officer in Pleasant View, a suburb
in the shadow of the Wasatch Mountains, for more than a decade.
As a night patrolman for years, Done saw the epidemic at its
worst. He picked up teenagers "high as kites" in their cars,
broke up parties where pills or heroin was on the tables, and got
called in when kids overdosed, a common occurrence a few years
back.

Weber County, where the town is located, has the third-highest
drug-overdose death rate in Utah at 30.8 deaths per 100,000 in
2015.

One night, Done had to respond to four overdoses, one after
another. They all died. "I almost told my chief that if I got one
more overdose, I was done. It's not a pretty sight," Done told
Business Insider.

There's no shortage of middle-class suburban counties that have
been ripped apart by overdose deaths. Norfolk County,
Massachusetts; Scioto County, Ohio; Armstrong County,
Pennsylvania. The list of places with spiking overdoses goes on.

There
have been efforts to greatly expand access to naloxone, a
life-saving drug that reverses overdoses. Advocacy organizations
and nonprofits like the Clinton Foundation have given out tons of
naloxone kits to those at risk, and the CARA Act includes
measures to make it more available to the public, police, and
first responders.

There was no naloxone on one of the most harrowing days of
Peterson's life. Not long after leaving her first stint in
treatment, Peterson and her boyfriend rented out a townhouse
using money that he received from a $100,000 life-insurance
policy after his father died.

After word got around, the townhouse became the spot for
young addicts in Pleasant View. Peterson and her boyfriend burned
through the rest of the money while dealers turned friends sold
dope in the living room and kids shot up in the rooms upstairs.
The house was littered with baggies, drugs, needles, and spoons.

One night, a kid Peterson barely knew overdosed in the bedroom.
Everyone in the house scattered, leaving Peterson alone with him,
a needle stuck in the kid's arm.

Done pulled Peterson aside at the scene and told her that she was
going to be next if she continued using. He'd met her dozens of
times before, on patrol, and had taken to trying to help her
escape her addiction. He told her that if she entered treatment
they wouldn't charge her for anything, so she did.

But that wasn't enough of a wake-up call. She failed out of
treatment, again. It was another two years of treatment and
relapse, arrests and jail time, drug court and parole, and
finally a year in the Utah State Prison before she broke free.
She has been clean since, she said, and she has begun the long
process of putting her life back together.

Andi Peterson is one of the lucky ones. Far more of the victims
of the crisis end up stuck in the relapse cycle or, like the
young boy in the townhouse, overdosed and alone.